Community issues in hospital ethics consultations

Farrell, Pauline (2014) Community issues in hospital ethics consultations. Practicum Report. Memorial University of Newfoundland. (Unpublished)

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Abstract

Clinical ethics committees are developed to attend to the ethical issues surrounding patient care and clinical practice. The members of these committees support and guide healthcare professionals when dealing with these issues. Unfortunately, there has been limited research on ethics committees/services in the community with the majority of research focusing on the hospital setting. In this report I describe a qualitative research study that I conducted as part of a larger study on community ethical issues and services being conducted by my practicum supervisor. The purpose of my study was to identify ethical issues related to the community in the summaries of ethics consults submitted to a large, regional health authority. Prior to initiating this study I reviewed the literature and found that there is a need to explore what ethical issues exist that have implications for care in the community, and how these issues are currently being managed. In this report I outline the findings of a content analysis of 47 ethics consults. Included is a summary of issues from these consults as well as a description of the main themes identified pertaining to ethical issues in the community. These themes include: (1) Lack of resources to meet patient/client needs; (2) Family requesting futile interventions/treatment; (3) Respect for patient/client wishes; (4) Patient’s/client’s behavior harmful to self and/or others; (5) Timely communication; (6) Patients/clients participating in unsafe behavior; (7) Patient’s/client’s needs unable to be met in current setting; (8) Perception that unethical care is being provided; (9) Legally prevented from helping; (10) How to protect patients’/clients’ rights; and (11) Rights of a patient/client versus rights of others. The findings of the study are discussed and implications for practice, education and research are reviewed. I conclude this report with a discussion on the advanced practice nursing competencies used to complete this practicum. The data from this study will be included as part of a larger qualitative research study of ethical services and ethical issues related to the community.

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